Troponin status predicts 30-day in-hospital mortality

Abstract

Aim: To evaluate the prognostic value of high-sensitivity cardiac troponin (hscTnT) levels in unselected emergency medical admissions. Methods: We report on all hscTnT tests in emergency medical admissions, performed over an eight year period from 2011-2018. The prognostic significance of hscTnT was related to 30-day in-hospital mortality with multivariable logistic regression, adjusted for Acute Illness Severity Score, Comorbidity Score, Sepsis, and Deprivation Status. Results: There were 52,214 admissions from 28,982 patients during the study period. HscTnT level was a univariate - odds ratios (OR) 1.67 [95% confidence intervals (CI): 1.60-1.73] and an independent risk predictor in the multivariable logistic regression model - OR = 1.23 (95%CI: 1.16-1.29). 30-day in-hospital mortality increased as a linear function of hscTnT; not performed = 3.6%, ≥ 25 ng/L = 5.3%, > 100 ng/L = 7.4%, > 1000 ng/L = 8.8%. Increasing Comorbidity Score exacerbated risk; 30-day in-hospital mortality at a Score of 6, 10 and 16 points for those with no hscTnT performed or hscTnT < 25 ng/L were 1.8%, 6.5% and 31.3% respectively; for hscTnT ≥ 25 ng/L these increased to 2.2%, 8.8% and 41.3%. Conclusion: HscTnT is prognostic in acutely ill medical patients; incorporation into hospital mortality predictive algorithms appears warranted.